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Dissociation
Working with Dissociative Identity Disorder (DID)
What is Dissociative Identity Disorder?
My Experience of Dependency in Dissociative Disorder
What the Heck is Dissociation Anyway?
My New Computer
The Therapeutic Alliance
Individual Differences and Sailing
Understanding the Realities of DID
Learning To Cope With Dissociation
Impressions from Dissociation
Working with Dissociative Identity Disorder (DID)
Increasing numbers of people are presenting to counsellors, churches and voluntary organisations with trauma from early life abuse or events. For some of those individuals the trauma has been extreme and for others it has also been perpetrated in ritual or group settings of cults or paedophile rings. Survivors of such atrocities are often left suffering from sustained Post Traumatic Stress, Dissociative Disorders and Dissociative Identity Disorder along with a complex range of life issues.
DID is neither a psychosis nor a personality disorder but rather a sophisticated survival mechanism for coping with overwhelming, often enduring, childhood trauma.
Denial, disbelief and misdiagnosis all mitigate against survivors receiving the appropriate help and achieving a full recovery. Without sufficient awareness and understanding counsellors can become part of the problem rather than part of the solution.
“Dissociative Identity Disorder is a complicated clinical disorder. Treating it requires a number of different perspectives. The practitioner cannot take a narrow or purist point of view, but must understand in an historical and cultural context.” – Ross (1997)
“Treatment is long-term, intensive and invariably painful, as it generally involves remembering and reclaiming the dissociated traumatic experiences. However Dissociative Disorders can have the best prognosis of recovery of any severe mental health disorder, providing proper treatment is undertaken and competed.” – Sidran Foundation (2000)
Successful Treatment is more dependent upon the client/counsellor relationship than on which model of therapy is adopted. Seeing the client as a person rather than a “condition”, and listening to and learning from the client are more important than the number of books or articles that have been read.
“Twentieth-century psychiatry has grossly underestimated the amount of dissociation in the normal population, and in clinically disturbed individuals.” – Ross (1997)
What Is Dissociative Identity Disorder?
This brochure is copyright 1994 by the Sidran Foundation and is reprinted here for personal use only. Copies of this brochure are available from Sidran in packages of 50 for a small fee.
The growing recognition of psychiatric conditions resulting from traumatic influences is a significant mental health issue of the 1990s. Until recently considered rare and mysterious psychiatric curiosities, Dissociative Identity Disorder (DID) (until very recently known as Multiple Personality Disorder - MPD) and other Dissociative Disorders (DD) are now understood to be fairly common effects of severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse.
In 1994, with the publication of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-IV, Multiple Personality Disorder (MPD) was changed to Dissociative Identity Disorder (DID), reflecting changes in professional understanding of the disorder, which resulted largely from increased empirical research of trauma-based dissociative disorders.
Post-Traumatic Stress Disorder (PTSD), widely accepted as a major mental illness affecting 9-10% of the general population, is closely related to Dissociative Identity Disorder (MPD) and other Dissociative Disorders (DD). In fact, as many as 80-100% of people diagnosed with DID (MPD) also have a secondary diagnosis of PTSD. The personal and societal cost of trauma disorders [including DID (MPD), DD, and PTSD] is extremely high. For example, recent research suggests the risk of suicide attempts among people with trauma disorders may be even higher than among people who have major depression. In addition, there is evidence that people with trauma disorders have higher rates of alcoholism, chronic medical illnesses, and abusiveness in succeeding generations.
What Is Dissociation?
Dissociation is a mental process which produces a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity. During the period of time when a person is dissociating, certain information is not associated with other information as it normally would be. For example, during a traumatic experience, a person may dissociate the memory of the place and circumstances of the trauma from his ongoing memory, resulting in a temporary mental escape from the fear and pain of the trauma and, in some cases, a memory gap surrounding the experience. Because this process can produce changes in memory, people who frequently dissociate often find their senses of personal history and identity are affected.
Most clinicians believe that dissociation exists on a continuum of severity. This continuum reflects a wide range of experiences and/or symptoms. At one end are mild dissociative experiences common to most people, such as daydreaming, highway hypnosis, or "getting lost" in a book or movie, all of which involve "losing touch" with conscious awareness of one's immediate surroundings. At the other extreme is complex, chronic dissociation, such as in cases of Dissociative Identity Disorder (MPD) and other Dissociative Disorders, which may result in serious impairment or inability to function. Some people with DID(MPD)/DD can hold highly responsible jobs, contributing to society in a variety of professions, the arts, and public service. To co-workers, neighbors, and others with whom they interact daily, they apparently function normally.
There is a great deal of overlap of symptoms and experiences among the various Dissociative Disorders, including DID (MPD). For the sake of clarity, this brochure will refer to DID(MPD)/DD as a collective term. Individuals should seek help from qualified mental health providers to answer questions about their own particular circumstances and diagnoses.
How Does DID(MPD)/DD Develop?
When faced with overwhelmingly traumatic situations from which there is no physical escape, a child may resort to "going away" in his or her head. This ability is typically used by children as an extremely effective defense against acute physical and emotional pain, or anxious anticipation of that pain. By this dissociative process, thoughts, feelings, memories, and perceptions of the traumatic experiences can be separated off psychologically, allowing the child to function as if the trauma had not occurred.
DID(MPD)/DD is often referred to as a highly creative survival technique, because it allows individuals enduring "hopeless" circumstances to preserve some areas of healthy functioning. Over time, however, for a child who has been repeatedly physically and sexually assaulted, defensive dissociation becomes reinforced and conditioned. Because the dissociative escape is so effective, children who are very practiced at it may automatically use it whenever they feel threatened or anxious -- even if the anxiety-producing situation is not abusive.
Often, even after the traumatic circumstances are long past, the left-over pattern of defensive dissociation remains. Chronic defensive dissociation may lead to serious dysfunction in work, social, and daily activities. Repeated dissociation may result in a series of separate entities, or mental states, which may eventually take on identities of their own. These entities may become the internal "personality states," of a DID(MPD) system. Changing between these states of consciousness is described as "switching."
What Are The Symptoms Of DID(MPD)/DD?
People with DID(MPD) may experience any of the following: depression, mood swings, suicidal tendencies, sleep disorders (insomnia, night terrors, and sleep walking), panic attacks and phobias (flashbacks, reactions to stimuli or "triggers"), alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms (including auditory and visual hallucinations), and eating disorders. In addition, individuals with DID(MPD)/DD can experience headaches, amnesias, time loss, trances, and "out of body experiences." Some people with DID(MPD)/DD have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed).
Who Gets DID(MPD)/DD?
The vast majority (as many as 98 to 99%) of individuals who develop DID(MPD)/DD have documented histories of repetitive, overwhelming, and often life-threatening trauma at a sensitive developmental stage of childhood (usually before the age of nine), and they may possess an inherited biological predisposition for dissociation. In our culture the most frequent precursor to DID(MPD)/DD is extreme physical, emotional, and sexual abuse in childhood, but survivors of other kinds of trauma in childhood (such as natural disasters, invasive medical procedures, war, and torture) have also reacted by developing DID(MPD)/DD.
Current research shows that DID(MPD) may affect 1% of the general population and perhaps as many as 5-20% of people in psychiatric hospitals, many of whom have received other diagnoses. The incidence rates are even higher among sexual abuse survivors and individuals with chemical dependencies. These statistics put DID(MPD)/DD in the same category as schizophrenia, depression, and anxiety, as one of the four major mental health problems today.
Most current literature shows that DID(MPD)/DD is recognized primarily among females. The latest research, however, indicates that the disorders may be equally prevalent (but less frequently diagnosed) among the male population. Men with DID(MPD)/DD are most likely to be in treatment for other mental illnesses, for drug and alcohol abuse, or incarcerated.
Why Are Dissociative Disorders Often Misdiagnosed?
DID(MPD)/DD survivors often spend years living with misdiagnoses, consequently floundering within the mental health system. They change from therapist to therapist and from medication to medication, getting treatment for symptoms but making little or no actual progress. Research has documented that on average, people with DID(MPD)/DD have spent seven years in the mental health system prior to accurate diagnosis.
This is common, because the list of symptoms that cause a person with DID(MPD)/DD to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who are diagnosed with DID(MPD)/DD also have secondary diagnoses of depression, anxiety, or panic disorders.
Do People Actually Have Multiple Personalities?
Yes, and no. One of the reasons for the decision by the psychiatric community to change the disorder's name from Multiple Personality Disorder to Dissociative Identity Disorder is that "multiple personalities" is somewhat of a misleading term. A person diagnosed with DID(MPD) has within her two or more entities, or personality states, each with its own independent way of relating, perceiving, thinking and remembering about herself and her life. If two or more of these entities take control of the person's behavior at a given time a diagnosis of MPD can be made. These entities previously were often called "personalities," even though the term did not accurately reflect the common definition of the word as the total aspect of our psychological makeup. Other terms often used by therapists and survivors to describe these entities are: "alternate personalities", "alters," "parts," "states of consciousness," "ego states," and "identities." It is important to keep in mind that although these alternate personality states may appear to be very different, they are all manifestations of a single person.
Can DID(MPD)/DD Be Cured?
Yes. Dissociative disorders are highly responsive to individual psychotherapy, or "talk therapy," as well as to a range of other treatment modalities, including medications, hypnotherapy, and adjunctive therapies such as art or movement therapy. In fact, among comparably severe psychiatric disorders, DID(MPD) may be the condition that carries the best prognosis, if proper treatment is undertaken and completed. The course of treatment is long-term, intensive, and invariably painful, as it generally involves remembering and reclaiming the dissociated traumatic experiences. Nevertheless, individuals with DID(MPD)/DD have been successfully treated by therapists of all professional backgrounds working in a variety of settings.
Where Can I Get More Information?
The Sidran Foundation is a publicly-supported, non-profit organization devoted to advocacy, education, and research on behalf of people with psychiatric disabilities. The foundation is particularly interested in providing support and advocating empowerment for people who have survived psychological trauma, and has developed resources in this area. The Sidran Foundation Bookshelf is a mail-order book service providing annotated catalogs and home-delivery of books, audio and video tapes, and informational materials of particular interest to DID(MPD)/DD survivors, their supportive family and friends, and their therapists. The Sidran Press is publisher of the highly acclaimed Multiple Personality Disorder From the Inside Out, a collection of writings about living with MPD by 146 survivors and their significant others, and Dissociative Disorders: A Clinical Review, a state-of-the-art survey of diagnosis, treatment, and research written by six of the nation's foremost MPD/DD specialists. In addition, Sidran has compiled lists of MPD/DD support and treatment resources and conducts educational workshops.
All information on these pages © the Sidran Traumatic Stress Foundation, 1995-2000
My Experience of Dependency in Dissociative Disorder
Having had a period of profound depression, in the last year, during which dissociative episodes were intrusive & disturbing, I would like to offer some thoughts on my varied experiences of dependence through different stages of life. My viewpoint is as a survivor of sexual abuse early in life, with a background of paternal drunkenness & violence, well intentioned but inadequate maternal input, with both parents suffering periodically from psychotic depression & my mother having grand mal epilepsy.
Reading recently about attachment theory, I found I identified very much with the ‘insecure & disorganised’ attachment, where the ‘parents are experienced as either frightening or frightened and therefore not available as a source of safety or comfort. This compounds the child’s anxiety. The infant is left with an “irresolvable conflict” to approach the attachment figure who is also the cause of the anxiety.’
I have long been aware that I seek out ‘father figures’ who contrast strongly with my actual father. Whether in a teacher, vicar, friend’s father, tutor, boss or colleague I would search for kind eyes, interest, affirmation, non-aggression, humour and lack of sexual overtones.
The difficulties with acquiring heroes in this way include their lack of choice, their elevation to ‘superdad’ making disappointment inevitable, along with a vulnerability to their level of approval, guidance, ideas, moods & whims, giving them influence, for good or ill, to a disproportionate degree. My depth of need & my fear of rejection meant my approach to these potential sources were people pleasing, unduly passive & non-critical.
Side effects that did society no harm were that I worked really hard, tried to be really good & tried to present an image of a nice, smiley, friendly face at all times, sleep being the only relief.
Then in my nineteenth year came a fundamental change of direction. I became a Christian. That was twenty-six years ago and is something I have never regretted, but you may not be surprised to hear that I brought my ‘stuff’ with me into adulthood. So my approach to Christianity was to look for admirable heroes and to try really hard at everything to look the part at least.
It took vast amounts of energy to live my life as I thought I should. If the Christian teaching emphasis was on my responsibility, effort, perseverance, failing, wrongdoing etc., then it came through loud and clear. If the words were about making oneself vulnerable, resting, trusting, being accepted, receiving, letting go etc., then I could hear for others, but they didn’t ring true for me.
Later in life, when I could no longer keep anxiety at bay, I began to suffer depression with dissociative symptoms. Jumping ahead in time I will describe the help I have received in the past year. When the symptoms and stresses became intolerable, I asked to see a psychiatrist, began medication and was referred on for psychotherapy. My helpers are one female and one male. I began to trust both therapists, and to work through issues, for a while needing inpatient care.
Some characteristics of my helpers’ approach seem key to me as a dissociative patient. They are reliable, with consistent boundaries around appointments. They listen and hear what I’m saying. They adapt their response to whether I speak more from adult or child. They show empathy but not sympathy, so I don’t feel that I hurt them, or give them a problem. With my habit of over caring I would be inhibited by such feelings. They help me normalise what I’ve experienced by helping me understand. Rather than affirming my wrong thinking this strengthens my capacity to change, as I’m not using so much energy beating myself up.
I was reluctant to express needs, with counter dependency on the surface, but a potent drive for extreme dependency was nearby and I lived in mortal fear of being a nuisance. They accepted these confusions, and reassured me that I could safely express my needs. I felt dreadful if I made contact between sessions, a failure, stopping other’s therapy and wearing them out. But they reassured me and used the calls to arm my self-talk, grounding etc. I made some notes based on the calls, which I use instead of an actual contact at times. Knowing that I could safely ring if I had to reduced my need to keep checking them out. I realise I am idealising them, but the secure dependency I now have is a bridge, not a destination. When the time with them is ending, I hope to have enough emotional eggs in enough baskets that I can survive making the odd omelette. Relating to them is helping me relate to bits of myself, the inpatient bit encouraged me to accept help from others, the group time has showed that I can form mutual relationships.
When I asked for help in a Christian context I met loving concern, but little understanding. I experienced both enmeshment and distancing at different times, as dissociative symptoms were confused with demonic activity and resulted in distressing and invasive deliverance scenarios. This eroded my self-confidence, loaded on the guilt and promoted further suppression of emotions. My passivity meant I took responsibility for not getting better. Poor boundaries are a danger in church circles. Christians often assume that physical contact is welcome. For survivors a hug may be the last straw that breaks down their defences, leaving them exposed and floundering, or retreating to the heartache of isolation. I feel that those with complex needs should have input from outside their usual church setting. This gives both client and counsellor some privacy and normality. Our desire to go the extra mile with those we help can mean that we slip from empathy to sympathy to over involvement to enmeshment. When client’s symptoms are confusing, and progress slow, there can be a reluctance to ask for professional help, which should be overcome.
There is much that churches do extremely well. Support of the family, help with meals, lifts for children, babysitting for visits or appointments. Loving acceptance and reassurance of the vulnerable person as they re-emerge into public can ease their anxieties. The church can give ongoing encouragement, building of self-esteem and the opportunity to develop both dependent and interdependent relationships as well as autonomous roles in time.
Aahbee, March 2004.
What the heck is dissociation anyway?
Comments on a paper given by Paul Dell at International Society for the Study of Dissociation Conference in 2002.
I listened to a taped talk by Paul Dell titled ‘What the heck is dissociation anyway?’ (paper delivered at the International Society for the Study of Dissociation Conference, 2002) and felt really excited – here was a guy who understood. He included a lot of technical information regarding the diagnostic manuals used by the medical professions, and then focussed on research from published papers on what people with dissociation actually experienced.
Dell started with the well known classic picture of DID: ‘ a person with DID switches from one personality to another, each personality has its own identity and the host personality has amnesia for the activities of the other personalities.’ This classic picture of DID is clearly depicted in DSMIV and is widely known in the general culture. Dell believes that the classic picture of DID is skewed to the point of being a very poor representation of DID.
The diagnostic manuals (DSM, and to some extent the ICD), concentrate on switching and amnesia in their diagnosis of DID. But Dell states that this switching and amnesia is happening for a very small amount of time. Putting two of his comments together, the amount of time switching occurs might average less than half of one per cent. In addition, Dell says ‘People are not confused because they switch. They are often unaware of the switching. Rather, they are confused by what they are experiencing when they do not switch. If the everyday self is not aware of the switching and lost time, then it isn’t a problem. Diagnosis is therefore difficult if the symptoms insisted upon for DID are so infrequent (and often going undetected by the patients themselves).
Dell has concentrated on the subjective, phenomenological experience of chronic dissociative symptoms. He says that from a subjective perspective, dissociative symptoms are startling invasions of one’s mind and one’s experience. His definition of dissociation is as follows: dissociative phenomena are unbidden, jarring intrusions into one’s executive functioning and one’s sense of self. Research has shown that for 40% of the time DID patients are struggling with these jarring intrusions, and Dell surmises the ratio of intrusions to switching may be in the order of 100:1. Therefore, Dell believes, the classic picture of DID has ignored the experiential core of DID.
The DSMIV says that the domain of dissociative phenomena is bounded by consciousness, memory, identity and perception. ICD10 says that the domain of dissociative phenomena is bounded by memory, identity, sensation and bodily movements. But in fact there is no human experience that is immune to invasion by dissociative symptoms. They can occur as body sensations, feelings, impulses, actions and thinking. These come pushing through from the split off parts of the self that are frozen in time, holding trauma, pain, troubling or compelling thoughts, feelings, somatic energy, and the whole range of human experience.
The essential difference between partial and full dissociation is the person’s contemporaneous awareness of his or her actions. Full dissociation entails amnesia. During partial dissociation, dissociative individuals have contemporary awareness of all other dissociative intrusions. They feel them, they know them, they’re weird and they say “I feel like I’m losing my mind”. With the exception of amnesia, all dissociative events are partial. And, in a person with DID the overwhelming majority of dissociative events are partial, not full.
Dell’s emphasis on the jarring intrusions rather than the amnesia is most welcome. The distressing intrusions are what cause most DID patients to seek help. The amnesia they may not know about, but with the help of a therapist any unremembered events can be reclaimed as dissociated parts of the self feel safe enough to come to the surface, and the everyday self feels safe enough to allow release and resolution.
Extra thought: Without (or before) the jarring intrusions into their minds and bodies, people who have successfully used (full) dissociation as a defence/coping mechanism are functioning ‘OK’ and do not have a disorder. It is the jarring intrusions that cause the dissociation to become a disorder.
My New Computer
I’ve just taken delivery of an up to the minute, spanking new computer and I’m finding it hard work setting it up and getting going, so I’m keeping the old one going while I get used to the new one. But when I’m up and running with the new computer its going to be so much better.
My old computer is a dear friend. We know each other, but we’re not functioning as well as we used to. We get stuck more frequently. There are so many things I can’t do. I can’t open many files attached to emails. I used to, but now all that comes up is “Sorry this view is not available”. I can’t load the software to handle running a website. I slow down and often I don’t have enough memory. I have to remember not to do too many things at once or I run out of memory and the whole thing seizes up and closes down.
A bit like me really. Only I can’t just send off for a new computer and discard the old one. I’ve got to make do with the old one and try and work out what is causing the seizing up and how to release a bit more memory. You can buy extra memory for the old computer. We did that, but actually it didn’t seem to solve anything - obviously something fundamental is causing it to work less well than it did. I also used to be OK (after a fashion). I did wonder occasionally if I was only functioning in part of me, I felt a bit shallow - was there more I wasn’t tapping into? But I got by. Had the occasional breakdown, seize up, overheat. But not enough for anyone to get a ‘mechanic’ in for more than a cursory glance.
Now after a good run at life, seemingly functioning pretty well, I’ve found the breakdowns are more frequent, the lack of memory, especially working memory, almost a permanent problem. Frequently nowadays, just as on my old computer, a message pops up on my screen “There seems to be another network running underneath the one you are using - do you want to shut it down?” I press the ‘yes’ button, but it keeps on appearing. If I knew why that happened I could do something about it...
But now I’ve found some (mostly old) files that I didn’t know were there, ones that were taking up space and making me feel shallow. Sometimes they pop onto my screen without any warning. When that happens occasionally I can find the ‘close’ button. Often I can ‘minimise’ and carry on with the intrusive file in the background. But other times the old file overwhelms and the system shuts down and I need time out before ‘booting up’ again. In the end I’ve had to find an ‘engineer’ who is happy to take on a long term project and work on the memory and seizing up problem while trying to keep me up and running in between times.
THE THERAPEUTIC ALLIANCE
As Experienced by a Multiple with DID
It is impossible to over-estimate the value of a sound and loving therapeutic relationship, particularly as experienced by one who is suffering from DID. It may well be that the therapist’s presence introduces the first positive influence into the client’s life, a life that comprises a complex system of dissociated alter personalities who co-exist in chaos and confusion. Such a person never feels safe, until, that is, she learns to trust, and it is that ingredient in the therapeutic alliance that is of the utmost and absolute importance, for without it there can be no progress. In parallel with the development of trust there will grow an increasing sense of affirmation, and hope that life can, indeed, change. Without this hope the client might find herself damned to live out a life handicapped by profound bouts of memory loss, and answerable for actions of which she has no recollection.
It may help to try and explain a little how this is experienced by an SRA survivor who has DID. As an adult, her everyday life may seem a horror world to her. Over any 24 hour period she may find herself completely lost in a different city or location, feeling ‘possessed’ and driven by an inner dictator, incoherent with fear, in the daytime or at night-time, at work or in the home, in public places dressed or undressed, wet or dry, at conferences, in cupboards, in the arms of strangers or abusers, or learning at college again, flat-seeking, counselling, crippled with body pains, at seminars or facing difficulties in a marriage that has no shared history.
Good therapy can change this horror world, but the therapist needs a stout heart and an unequivocal belief that love never fails. For into the client’s chaotic existence s/he can bring a calmness and a certainty that can only come from his/her rootedness in their own identity, in their own sense of being one who is unconditionally beloved1. The client will intuit this almost at the first meeting. It will transcend her fear and suspicion, and alert that deep unconscious part in her that has sought a place of safety all her life. Only those who are safe with themselves can be a place of safety to others.
This sense of safety will provide the foundation upon which the therapeutic relationship can develop into a deep and trusting one where good work can be done. Sometimes this safety will be experienced vicariously by an inner watching alter who might see the therapist as one who:
- behaves with integrity and in a trustworthy manner;
- is not afraid of the alter parts that the client herself is afraid of;
- appears to have an endless supply of love;
- seems to have the client’s best interests at heart (that is, all the client’s alters)
- is available to help any of the alter personalities whenever they experience difficulties;
- believes what each and every one of the alter parts say;
- is non-judgmental, loving and godly
- is constant in his/her approach;
- is never fazed!
Perhaps, most importantly, the therapist must be willing (and able) to enter into the hitherto unmentionable areas of the client’s life with her as she tentatively owns for herself the utterly dreadful grief and pain, the killings, the sacrifices and losses, the terrible, agonizing and unspeakable memories, the profound sense of guilt for actions committed and the shame for actions experienced. It is important to remember here that there will never have been anyone else who has ever indicated to the client that it is acceptable to speak of these things. And because the details are so graphic and cruel, the client will feel disgusting and cruel in the telling of them. There will be parts of him/her that will descend into irrational fear as they hear what the client is saying, and the therapist must be especially constant in the expression of his/her unconditional love and regard at this stage. The client’s greatest fear will be that her therapist will no longer hold her in the same regard once s/he hears of these events.
Another anxiety may be that her therapist views her merely as ‘a client’ and not as one who has entered into a genuine relationship in order to share at this level. For a client to feel that she is simply one of many clients with whom her therapist works is experienced as crushing in the extreme, as she has invested all that she has to give into the relationship. At this stage in her therapy it will be inconceivable to her that her therapist may have other, similar relationships, or that s/he is not wholly present for her. However, at a later stage it is possible to work this through to a place where she can recognise that her therapist can have other relationships without impacting on or devaluing her own. But it is important to understand that this will not happen, and indeed cannot happen, until the insecure attachment issues that are at the root of the problem, are resolved.
In many cases, those with DID have never formed a secure attachment with a loving and trustworthy adult when they were a child. If an attachment subsequently forms with the therapist (and some would argue that this is a necessary stage in the healing process), then the client experiences the therapist’s actions as disproportionately magnified. For example, when the therapist goes away, or is suddenly or inexplicably unavailable, or does not do what s/he promises, or is not clear about the times and method of contact, the client is likely to become overwhelmed by fear or feelings of anxiety and distress. Past experiences of powerful adults leaving and/or returning have undoubtedly been associated with punishment and the setting of impossible tasks (commissions), and so the same feelings in the present can catapult child alters back into the nightmare scenarios of the past. In the here and now the client will probably feel very ambivalent about the therapist’s return, as the feelings she experiences will be sourced from within her internal family. It is helpful if the therapist is sensitive to this apparently irrational behaviour surrounding their relationship as it can be very distressing to the client. It may also explain why a client is so easily derailed by the therapist’s absence.
It might seem that the depth of relationship that this amount of trust and safety creates could only be experienced as positive and beneficial. However, as indicated, this is not always the case and it can create problems of a different nature if this is not recognised by the therapist. The resulting distress to the client can cause a catalogue of grief and pain, flooding of recovered memories and even a re-enactment of the disempowerment experienced by her as a child or young adult. For example, internal conflict can unintentionally be created by a therapist who assumes the role of protector, as this may be experienced by the client as control, especially if decisions are made on the client’s behalf for her ‘own sake’. Feelings of outrage, abandonment or rejection can resurface so powerfully that a client may well experience self-harm or even suicidal ideation. For there is nowhere to place these feelings – certainly they cannot be accorded to the therapist (who surely is only acting in the client’s best interest) – and so they are turned inward once again and exacerbate the brewing of self-harm and despair. Blue prints of the past are repeated, as how could the child place her feelings of righteous anger and grief upon the parents on whom she depended for her survival?
It seems to me that working with clients with MPD/DID is far from easy and requires a long term commitment. It can take several years for all the dissociated parts to learn to trust a therapist sufficiently to lower the walls of amnesia. But it can be life-transforming work, both for the client and the therapist. The intensity of the work requires them to be strangely vulnerable to one another and this generates space for God to move. Certainly my own spirituality has been enhanced and developed within this unique relationship. God has touched my soul and awakened me to a source of nourishment that is implicit and available in the space created when client and therapist work at this depth. This spiritual encounter, together with the presence of my therapist, has recreated the conditions necessary for human flourishing, and I now feel safe, accepted and loved for who I am, and not judged for a history and upbringing that I did not choose.
‘Wispy’, November 2002.
1 See Henri Nouwen, Life of The Beloved
Individual differences and Sailing
Edited notes from an email posted by Richard Kluft on the ‘Dissociative Disorders Email Discussion Forum’ recently.
Reproduced with permission.
(E)very day each patient confronts me (and my patient him or herself) with unique challenges, and forces us to reinvent our therapeutic work together. To me, the work is not unlike sailing. When you sail, you usually just can't point the boat where you want to go and get there. Instead, aware of the changes in the wind and the current, and unable to sail directly to many degrees of the compass, you do your best to plot a course, or at least determine a strategy about how to tack back and forth, knowing that its very essence is its malleability, and that no voyage will ever work out without a constant attention to the changeability of the enterprise.
In a given day I may see a dozen DID patients, and in each case my approach to each patient, and each patient's personality system's responses to my efforts may be different. This has always made it difficult for me to offer general advice about what to do, or, even to describe what I do.
I would urge list members to give thought (as Connie Wilbur used to say:) "in depth and at length" to advice that is offered. Some ideas may be great, but not fit with the rest of a given therapist's approaches, or the overall tenor of a particular treatment, or be workable with a particular patient.
When we are dealing with a patient's pain and suffering, we want to eliminate or at least minimize its capacity to be hurtful in the present; i.e., (and here I think I may be paraphrasing Janet) we want to transform a symptom into a memory, something that can be recalled and discussed, but which does not intrude itself into daily life in some dysphoric and dysfunctional manner. Patients' individual styles and beliefs may play powerful roles in what is needed. For some patients, a focus on the cognitive distortions and consequences of the trauma may suffice; for others, nothing less than an earthshaking emotional outpouring drains the past experience of its hurt.
When patients are being traumatized, and their minds are managing to contain and protect themselves from as much pain as possible, they do not all arrive at the same strategies, or dissociate things in the same manner as others may. What they do is not universally the same. Moreover, many will restructure their dissociative defences over time.
Richard Kluft is a well-known author, clinician, teacher, researcher, etc., in the field of dissociative disorders.
UNDERSTANDING THE REALITIES OF DID
The value of a research Project
I recently completed an MSc in Integrative Psychotherapy at the Sherwood Psychotherapy Institute in Nottingham. Integral to the programme was to do a research dissertation in an area that interested us in the field of psychotherapy. My title was ‘An Exploration into One Client’s Perspective of Living with Dissociative Identity Disorder and the Impact of Therapists’ Responses’. The following is a summary, some of it verbatim, of the research I undertook.
More than a decade ago I became fascinated by what was then known as Multiple Personality Disorder, now known as Dissociative Identity Disorder. The story of Sybil (1973) in part stimulated this interest but I was keen to go beyond just watching a film dramatisation (1976) and reading a biography. I wanted to gain a much better understanding of this presentation.
When I met and became friends with ‘Katherine’ [not her real name], I was continually amazed, and continue to be so, by the capacity of the human mind to have done something so creative and remarkable to protect itself and survive from unimaginable horrors. The phenomenon of dissociation was not a new concept to me, having experienced and worked through some dissociative distress myself. To appreciate that the mind could go much further and create new ‘identities’ was therefore not hard for me to grasp.
At the onset of my training in psychotherapy I was already aware that this would be the area I would focus on for my research project, specifically how it would be formulated was not yet in my mind. It was my continuing friendship with Katherine that determined where the focus would be directed.
As I learnt more of Katherine’s story and her struggle to be healed from the traumas she had experienced during her childhood, teens and early adulthood, I was constantly impacted by her tenacity as she clung to the belief that she could move forward and no longer be so affected by the consequences of the abuse perpetrated against her. Katherine was already in therapy with her current therapist when I got to know her.
This had developed over time, with various struggles, to become a healthy therapeutic relationship within which she had grown and begun the healing process. She had not always had such positive experiences in individual therapy and, even whilst I knew her she had been to conferences, which included therapeutic group work that had been devastating for her.
As we talked about her experiences, what developed over time was an awareness of much ignorance and lack of acceptance for DID clients by some therapists or therapeutic groups. Stimulated by her frustration and hurt, I read around the subject and was struck forcibly by what appeared to be a lack of client perspective about the process of therapy for them.
Many theories, opinions and guidelines were given by therapists on how to work with this client group. Apart from biographies that were often a historical narrative of the abuse and reasons for the development for the DID, there appeared to be little that specifically addressed the impact of how therapists respond to DID clients, from the clients themselves. I knew then that I had found the heart of the research.
It was the lack of voice, and what was experienced, at least by Katherine, as marginalisation, for the DID person that was so compelling. Inevitably, the direction and methodology of the research would have to reflect this by being collaborative and working alongside the DID client, so as not to repeat a pattern. Katherine was enthused and, once I had established that there was good evidence for having a single story narrative in research, our minds were made up. So began the journey into Katherine’s world of DID, her experiences of therapy and the impact that it has had on her.
These were my motivations for undertaking such an area of research and were confirmed to me by a significant gap in the psycho-therapeutic literature and research market in the seventy or so books and articles that I surveyed in an extensive literature review. This covered an overview of the historical beginnings of interest in the subject and then looked at some of the clinical and narrative literature available.
Encouragingly, recent material is just beginning to address this issue. Benatar (2003) states that if, as some believe, ‘all personality disorders are at bottom variations on dissociative processes, our DID patients may be our most informed teachers’ (2003:12). If this is so, then there needs to be much more than a statement of belief but documented experiences and accounts from DID clients and the impact of therapy on them.
The dissertation then followed with a section that developed a rationale for the methodology used; collaborative, with Katherine, using Participatory Action Research and a Narrative Methodology that were based on Atkinson’s (1998) and Etherington’s (2000; 2001; 2002) approaches. It also discussed the debate in qualitative and quantitative research and located this within the Integrative Psychotherapy tradition.
This methodology section also described the procedure for establishing the research project, how the data would be analysed and paid considerable attention to the ethical issues paramount to such a project. The conclusion to all this, which space does not permit expansion on, was that such a methodology would offer a unique insight into one person’s worldview of living with DID and the impact that therapists make on her.
The Findings and Discussion formed the main body of the research with verbatim comments from Katherine included. It did not give a narrative of her upbringing and the details of the abuse that caused her to develop DID. What was significant in the data and important for Katherine to give voice to was her experience of therapy, as a DID client, and what the impact on her has been, both positive and negative.
It demonstrated that for Katherine therapy has played a crucial part in her continuing healing and recovery. However, it is a therapy that supports a strong and open working alliance between client and therapist that is efficacious. Therapy that does not value this type of model is seen to be, from her data destructive, as damaging and not productive in moving forwards. The quantity of data that was provided by Katherine was extensive and so these findings and discussion were only able to reflect in part all that was expressed and raised.
Exploring Katherine’s experience of living with DID and the impact of therapists on her has been a challenging and insightful process. What has been most significant in hearing her story has been the importance of receiving therapy for her recovery and healing, without therapy this would have been an almost impossible task.
As is the case with most clients, what is pertinent for her is the quality of the therapeutic relationship and the establishment of a good working alliance. Although these are concepts that are readily accepted, particularly in Integrative Psychotherapy, what Katherine’s data presents is a perspective that highlights what a client may experience from a therapist’s interventions. For her to feel loved and, at least for a time, to be able to attach has been most significant. The data is as equally clear in what is not helpful; therapists using their potential power to profess knowledge or control in the therapy and by doing so not hearing and seeing what is most needed for the client.
What is especially painful is when the DID client is not believed or is seen as a multiple rather than a unique person with their own values and opinions. Katherine’s experience also highlights the difficulties of therapeutic group work for DID clients and leaves a challenge to the professional world, in finding formats that are safe and inclusive for the DID person.
The data demonstrates that with DID clients, whilst still maintaining a professional model there needs to be creativity, adaptability and openness. The challenge to therapists is to examine their own model of working and to explore more fully and bring into the therapy room an awareness of how marginalisation may feel. Therapists need continually to keep at the forefront of their minds the fact that DID people are often seen as a curiosity. What they do not need is to be an object of this in the therapist’s room or to be seen as a therapeutic challenge. From Katherine’s perspective, what she needs is understanding, commitment and unconditional acceptance. The client particularly needs to be valued as a unique individual and a good relationship between therapist and client developed and maintained. It is a way of therapy that is especially suited to an integrative approach and interestingly so, as DID represents an extreme loss of integration in the birth personality.
Employing a narrative methodology, with Participatory Action Research insight, had value in that a voice from a group that is often marginalized, or receives strong theoretical opinions about it, could be expressed and heard. The validity of the findings comes purely from Katherine’s experience, in that it is her story and experiences. Her story cannot be questioned, but how it is interpreted may be. Although this methodology has significant merit and value providing a unique experience of therapy as a DID client, it needs to be recognised that this is only one perspective and so cannot be taken as reality for all DID clients.
Others may have very different experiences or expectations of what for them would be efficacious in therapy. This is an area that would then benefit from further research, by collating more experiences of DID clients and the impact of therapy on them, what was helpful and healing and what was not.
Another area that would benefit from further exploration would be research into the viability and practice of therapeutic groups, which include DID; not an exclusive DID group. This is an area that Katherine has begun to think about and if her perspectives are heard, rigorous open research into the benefits of group work could be significant in the recovery journey for DID clients.
As I ended this project I could only continue to marvel at the wonders of the human mind, which was the place that began my interest and journey into Katherine’s world and experiences. As a therapist it has been invaluable in reminding me of the values that I hold and seek to maintain in my professional work with clients. Katherine’s story is a challenge in reminding me of the uniqueness of each individual and their own felt needs to journey towards healing and recovery. Those who need to develop DID for their survival bring this challenge into sharp focus.
Their struggle is often harder and more complex than most and, consequently, this is brought into the therapy room and the relationship with the therapist. We, as therapists who may choose to walk the path of recovery with this particular client group, have an enormous privilege to enter their worlds of fear and pain but often of enormous courage and hope in a different future. Will we be prepared for the challenge to walk alongside, listening and finding together a way for healing?
References
Atkinson R. (1998) The Life Story Interview: Qualitative Research Methods Series 44. USA: Sage Publications Inc.
Benatar M. (2003) Surviving the Bad Object. Journal Of Trauma and Dissociation 4(2): 11-25
Etherington K. (2000) Narrative Approaches to working with Adult male Survivors of Child sexual Abuse. The Client’s, the Counsellor’s and the Researcher’s Story. London: Jessica Kingsley Publishers.
Etherington K. (2002) Working together: editing a book as narrative research methodology: Counselling and Psychotherapy Research 2(3): 167-176
Etherington K. (2001) Doing Qualitative Research – a gathering of selves. Counselling and Psychotherapy Research 1(2): 119 – 125
Martina Platten Copyright 2004
Learning To Cope With Dissociation
The ability to dissociate during traumatic childhood events is a very helpful survival skill that comes more naturally to some of us than others. But difficulties can show up in adulthood if we continue to widely rely on dissociative coping mechanisms to get by.
For example, if a traumatised child switches off, blanks out chunks of memory, drifts into a fantasy world, or slips into role-playing another version of themselves, in order to handle unmanageable pain and trauma, then their situation may be no better or worse than it was before, however atrocious and abhorrent. But when an adult, with all the challenges of relationships, responsibilities, employment and self-protection, is triggered into using the same approaches then functioning may temporarily be seriously affected.
Some readers may find it difficult that I'm even hinting that there may be an element of choice in anything to do with dissociation. I hear you. I have DID myself and truly don't underestimate the humungous nature of the challenges involved. But the survivors with DID that I have had the privilege of meeting are strong, determined, creative and resourceful people whom I would not want to underestimate. Having said that, please take or leave what I write here as you find it helpful or otherwise, its only one person's point of view and likely to be as flawed as the writer! So that said, are there approaches that we can call upon to improve our coping skills? When pain levels exceed our coping skills then we may become overwhelmed. How might we balance the scales better, either by easing the pain or increasing our capacity to cope?
Being more kind to ourselves may help. Our childhoods, and perhaps adulthoods too, have been damaging and destructive enough already. I'm trying to learn to accept myself and offer comfort to my child parts. They had a really tough time, through no fault of their own, and they're way overdue for some kindness and understanding. Watch out though for a part(s) of you who speak very harshly and critically to any little ones, in fact sound all too much like those who hurt you in the first place. These accusers had very seriously flawed role models and what they have to say needs disputing, challenging and taking to therapy or otherwise tackling.
If you are learning something new, or having to change direction, then try to be your own best friend. I'm not much good at this yet, but I'm aiming to make my advice to myself gentler, more kindly, more forgiving and compassionate. Its what we would try and offer to others so why not to ourselves? Sometimes those 'love others as you love yourselves' needs turning base over apex into 'aim to love yourself as you aim to love others'! Be a fair judge. If you find yourself judging one of your child parts harshly, then maybe try and take a step back and think; if I, as an adult, saw that happening to an innocent child of that age how would I judge that child? And make no mistake; the younger person in an abusive scenario is always blameless.
If you become aware that internal tensions are rising then, if possible, try and find a pause button, ask for time out, move physically to a safer place or otherwise aim to ease your tensions back down to a manageable level. I realise that triggers sometimes hit like a Polaris missile out of nowhere at which point 'ease your levels' sounds like putting a sticking plaster on a bursting dam! As my psychiatrist very helpfully reassures me "Dissociative episodes will continue to happen from time to time until they don't need to happen, and then they'll stop happening." So when a crisis does crop up I try not to add to my difficulties by beating myself up for having the problem!
I respect the fact that ceasing to dissociate is not a goal for many survivors with DID. Hey, this is your life to live and your parts to care for! Powerlessness is such an issue for so many survivors that increasing your sense of choice and empowerment are, in my view, more important than any externally imposed goals or endpoints. We had absolutely no choice about this 'Round the World Tour' that our lives were put on by others, so surely we can begin to choose our travel companions, where and when we have our 'stopovers' along the way and if and how we're planning to eventually set up home!
Trust is a tricky business. Without some then the world can be a terribly lonely place, but trusting too much can lead to pain. Try and weigh up what you share of yourself with whom. Maybe test people with a little and see how they respond. If someone has repeatedly invaded your space and trampled on your feelings, then it's OK to draw some boundaries and limit their access. Think of a department store; cushions and towels, that aren't so easily damaged, are on open shelves; breakable items are in boxes on higher shelves; and the jewellery is in a glass cabinet and constantly watched over. People need to ask permission to view the precious items. Your insides are precious, so you decide who gets to see what. To quote my shrink again "Most people are trustworthy most of the time, but nobody is worthy of your total trust because they are only a human being." If possible over time choose to gradually develop a range of trusting relationships at different levels, so that no one person, situation or set of circumstances is make or break in terms of your being able to face the day. And then why not swim the channel after lunch? This is really tough stuff I'm talking about here isn't it? If it's any help then please know that I'm not writing anything I'm not working on for myself.
Perhaps try and develop a 'pending tray' for other people's potentially harmful comments about you or to you. By that I mean that when a verbal or written message is 'sent' then it's OK to hold it pending whilst you check it out a little. Then you can question whether what's being said is true, partly true, helpful, useful, something you want to absorb, perhaps the result of a misunderstanding on either part, or whether it could be more to do with the sender's own issues or problems and not something for you to take fully on board. If you're not clear what was meant then it's OK to ask questions until you are. Hopefully, in time, our self-protection will improve and unnecessary pain and relationship tensions reduced. And then swim the channel home again in the evening...
Learn to listen to your own instincts and impressions and weigh them up. Some of them may be fear-based and need challenging, but others may well stem from your finely tuned perceptive skills, developed out of necessity when your survival was at stake.
There's nothing remotely easy about the journey ahead, but then how many truly worthwhile things are easy? Let's aim to be our own best friends and give ourselves acceptance, value, kindness, encouragement and patience. With protection and enabling we can learn to both give and receive in increasingly creative and generous ways. Lets keep on keeping on!
Aahbee, October 2005
Impressions from Dissociation
Please let me say at the outset that the following thoughts have crystallised as I journey through a combination of personal and professional experiences of dissociation, which do not qualify me as an authority on the subject in any way. There will be omissions and inaccuracies in my writing, but perhaps seeing this as an offering from the 'buffet' rather than the 'set menu' will allow you to take or leave the contents as you feel appropriate.
However it is portrayed or misrepresented my understanding of dissociation is that it is a useful and creative tool that children can use in order to tolerate the intolerable and survive the catastrophic. Our human biology plays its part in that the survival mechanisms built in to us make a certain range of responses available to the child facing overwhelming threat. This gives common threads of experience and understanding between survivors with dissociative difficulties in adulthood.
But success isn't just down to our biology; it also requires determination and creative ability making each person's journey unique. I say success because dissociation works. It enables children to survive to adulthood through otherwise unbearable deprivation, threat, trauma and abuse. The cost is to the adult in the resources consumed along the way, holding the sometimes-fragile inner world together. The loss of positive childhood developments and learning experiences, which remain meshed up in the tangle of dissociative stages, can also be profound. Indeed I have at times felt that essential and indispensable parts of my very nature remain fragmented by the journey's wayside, awaiting a kindly lift home.
So what is dissociation like? It can never be described in its entirety, for the reasons mentioned above, but are there analogies or images, which may bring some understanding? Before I understood their meaning I found dissociative episodes bewildering, embarrassing, shameful, and unacceptably childish. Finding acceptance, understanding and hope for a path through to wholeness was quite marvellous. Initially the episodes seemed entirely beyond my control making them still more dreadful, but with help I gradually learned to look more closely at the lead-up to an episode. What were the warning signs of trouble ahead, could I put a pause button in somewhere, could I step back from the brink?
I tend to view unresolved pockets of intense emotion, such as grief, fear, or anger, with or without flashbacks, as balloons that I'm trying to hold underwater. Whilst I'm feeling strong and in control of myself I can exert the pressure I need to keep all the balloons under the surface. When my guard is down through fatigue, ill health, life events, or being caught off guard by an unforeseen trigger, then one or more of the balloons can burst up to the surface releasing sometimes overwhelming distress and exposing delicate areas of which I may have little understanding.
One image I find helpful is that of climbing up the steps to a steep slide, that once you've gone headfirst over the top the only option is down into dissociation, but what are the steps up about? The lower rungs may be non-specific; background stress levels, relationship difficulties, work pressures, ill health or perhaps hormone imbalances. The next few rungs may involve current life events, internal conflict, anxiety, bereavement, depression, key support people being absent, medication adjustments, sleep disturbance or issues emerging in therapy. We can learn to read the signs and be more kindly in our self-talk when there's a lot going on, perhaps as we would advise a close friend.
The further up the steps, then the harder it is to deal with unexpected triggers and nudges that come along. These may be tricky situations, harsh or unfair words, certain phrases, images, sounds or smells. Sometimes the reaction is immediate, though it may seem more like a depth charge happening in slow motion over hours or even days, making it even harder to work out and learn from.
The last few rungs are crucial, and probably highly individual, but may include; physical symptoms such as palpitations, shaking, sweating, dry mouth; a sense of becoming more remote, like blinkers coming over the eyes, hearing through cotton wool or a plastic bubble forming and enclosing; a sense of being alone against a hostile universe where calling out will only make things worse.
What worked in childhood, which was to withdraw to an imaginary place, is not so helpful in adulthood. There may be a degree of comfort and familiarity about the place; it was after all a reliable sanctuary from real life at the time. In adulthood though it may distance us from our usual sense of self, and some of the qualities that go with that such as self-protection and self-control. So instead of protecting and insulating us as it once did it actually takes away from our adult capabilities and may leave us vulnerable.
We may not be able, or even willing to give up dissociative defences altogether, but I believe we can gradually work towards making them less intrusive and disruptive of our adult lives; gradually recognising and adapting what we do under threat (real or perceived) and learning how to care for ourselves more effectively as we go along.
Yet what lies behind these defences? Is it all bad or can there be 'treasures from the darkness'? I suppose therapy, for me, is about connecting with those separate parts of myself without being overwhelmed by what they hold. Allowing the balloons to surface one at a time, in a safe place, with safe people who understand, and gradually letting all the hot air out of them. Hopefully one day there won't be any more balloons to pop up unannounced and explode in my face.
I suppose another image of 'connecting' versus 'dissociating' is of making fudge. When the cold ingredients are first put together in the pan they are separate and distinct. The butter is solid, the sugar is crystalline and the milk is liquid. A safe setting for heating is to have a strong saucepan and to warm the ingredients slowly and gently over a readily responsive heat source. Any sign of over-heating and you turn the heat down or take the pan off the heat altogether. Maybe therapy can be more like gentle warming, allowing 'connecting' to parts of our younger selves, as and when we are ready, whilst full-blown 'dissociating', 'splitting' or 're-traumatising' is more like boiling over. But unlike passive ingredients placed in a pan we can have the final say in which parts go into the recipe, whether or not we want to emerge as 'fudge', or whether some parts are best left distinct and separate. Just an idea and please ignore this if it jars with you in any way.
Imagine a set of Russian dolls, each coming apart and forming a separate doll, right down to the tiny baby at the core. In a 'good enough' childhood each successive layer of feeling and learning and developing fits pretty snugly and seamlessly over the previous one. What the smaller doll holds is mostly constructive and useful and the overall shape is a good basis for the next stage. When you look at the finished doll it may feel like one solid doll with no joins to be seen. But suppose one of the smaller dolls holds unbearable pain and trauma, which may have distorted development? One solution is to bandage that stage up so that the trauma can't be seen or felt, though there may be good memories and learning experiences bound up in there too. If the layers of bandage need to be thick then that doll may no longer fit in the set and have to be put on one side. If a number of stages have to be put on one side then the size and shape of the adult doll can be pretty hard to work out, and the insides may feel rather empty and unsteady. Remember though, nothing has been permanently lost; it's just that the damaged stages need some attention and TLC, with safe help in a safe place, where the bandages can come off and they can be gently helped to fit back in where they belong.
If you yourself have any dissociative difficulties then please know that none of this has any 'must' or 'should' or 'ought to' attached to it. I'm just exploring ideas and images that mean something to me, but if the shoe doesn't fit then I'd be the last one to try and force it on to your foot.
Another concept I've sometimes thought of is of the mind being a bit like a space station (but don't panic, I'm not into aliens). The idea is of there being a series of compartments surrounding a central 'adult communication core' from which we relate to the world around us. The compartments are like a lower semicircle of rooms in which we spent our developing childhood, and a kind of mirror-image upper semicircle in which we mostly spend our adult lives. In a 'good enough' childhood the balance of good and bad experiences from an essentially secure carer base means that we can still have access to most areas for retrieving memories or learning experiences. The enjoyment we shared, the difficulties we overcame and the strengths we developed will make a good base for our adult learning. In a traumatic childhood, where experiences were too difficult to grow through at the time, in the setting in which they happened, then these remain 'pending' as it were, and may be shut away in a sealed compartment to avoid their unwelcome intrusion into adult functioning.
Childhood areas to establish from
Being cared for - dependent and safe
View of self from carers - view of carers and safe others
Resting secure on carers base - beginning to explore and take risks
Making assertions through anger and protest - dealing with grief and loss
Adult areas to build on foundation
Independent and self-caring - caring for others
Confirming and building on view of self - extending views of others
Securing own base - reflecting, exploring and risk-taking
Refining our assertiveness - dealing with grief and loss
So our 'adult communication core' will often have access to these areas and positive inputs from childhood will add buoyancy and confidence to our adult learning. For example if a much-dreaded relocation to a new house and school actually worked out OK because of the support we had, then we can take a hopeful approach to a relocation as an adult. On the other hand if we lost a much-loved grandparent without discussion, sharing of feelings or acknowledgement of our grief then losses as an adult may re-open the unresolved pain, which we endured in isolation.
In this image I would see dissociation as having a sealed off childhood compartment holding intense unprocessed pain, usually only accessed involuntarily when someone hits a trigger or crumple button. Our old defence was to hop into an 'escape module' and jump ship to wherever was safer in our imagination. Now I would see the aim to be to voluntarily allow access to that awful unprocessed stuff, when the time and place are safe enough to deal with it for good. After all, we did survive, often against the odds, and memories cannot harm us of themselves, even if facing them can be a daunting and quite dreadful task, needing all the courage we can muster.
Aahbee, October 2005
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